Mycosis of the feet - symptoms and treatment

Mycosis of the feet(dermatophytosis,Tinea pedis) is a skin disease of the feet caused by pathogenic or opportunistic fungi.Skin changes on the feet are characterized by peeling, accompanied by itching.In case of severe injuries, against the background of red and swollen skin, erosions and deep cracks appear on the soles of the feet and in the spaces between the toes, which are accompanied by pain and make walking difficult.

The code according to the International Classification of Diseases, 10th revision (ICD-10) is B35.3.

The advent of modern antifungal drugs has improved the epidemiological situation, but mycosis of the feet still remains one of the most significant problems in dermatovenerology.The use of some drugs is limited in the elderly and in patients with chronic diseases.

Prevalence of foot mycosis.According to the World Health Organization (WHO), approximately 1/3 of the world's population suffers from fungal diseases, of which the most widespread are foot mycosis;the incidence grows every year.

According to dermatologists, 10-20% of the adult population suffers from foot mycosis;in men the disease occurs 2 times more often than in women and in the elderly more often than in young people.At the age of over 70, one in two patients has mycosis of the feet, which is associated with an increase in concomitant metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).Mycoses of the feet are being found more and more often in children.

Millions of people are currently affected by this disease.Workers in numerous professions are at risk: miners, athletes and military personnel.

Causes of foot mycosis.The most common causes of mycosis of the feet are dermatomycete fungi: Trichophyton rubrum (90%), Trichophyton mentagrophytes and, less commonly, Epidermophyton.Sometimes foot mycosis can be caused by fungi of the Candida genus.

Risk factors for foot mycosis:

• Exogenous (external): microtraumas of the skin of the feet (corns, calluses), cracking, increased sweating, wearing tight shoes, shoes made of artificial materials, failure to comply with personal hygiene rules, irregular washing of the feet and poor drying with a towel.
• Endogenous (internal): varicose veins and vegetative-vascular dystonia, leading to insufficient blood supply to the skin of the feet;hypovitaminosis;taking glucocorticosteroids, cytostatic, antibacterial and estrogen-progestin drugs, which reduce the general immunity of the body.

Mycosis infection of the feet can occur directly from a sick person, and can also be transmitted through contact and household contact (in the pool, bathhouse, gym, through shoes, towels, carpets, etc.).

If you notice similar symptoms, see your doctor.Do not self-medicate: it is dangerous for your health!

Symptoms of foot mycosis

The main symptoms of mycosis of the feet:

• itching;
• small cracks;
• erythema;
• peeling;
• bubbles;
• keratinization of the skin;
• unpleasant and pungent odor;
• burning and painful sensations.

The first signs of mycosis of the feet appear in the form of itching and burning in the interdigital folds of the feet, the skin begins to peel, crack, become red, and signs of swelling and inflammation appear.Complications can develop in the form of diaper rash and skin eczema.

Types of foot mycosis:

• erased - manifested by moderate itching and hyperemia (redness) of the skin;
• acute - accompanied by severe itching and skin damage in the form of cracks;
• nail mycosis (onychomycosis) - manifested by damage to the nails, which become thick and change color;

• similar to a diaper: weeping areas form;
• scaly: lamellar scales appear;
• hyperkeratotic - accompanied by rashes in the form of papules and plaques on the arches of the feet;
• dyshidrotic - manifests itself with the development of swelling, exuding areas and blisters.

Pathogenesis of foot mycosis

The skin is the largest organ of the human body and represents 15% of the total body weight.It performs many functions, first of all it protects the organism from the effects of external factors of a physical, chemical and biological nature, from water loss and also participates in thermoregulation.The skin is made up of three layers: epidermis, dermis and subcutaneous fat.

The epidermis (outer layer of the skin) is the main barrier against the penetration of fungi into the skin.It is a multilayered squamous keratinizing epithelium, which itself consists of five layers and functions as a barrier.Keratinocytes are the main cells of the epidermis.They contain the protein keratin, which creates the outer layer of the skin and gives it elasticity and strength.The keratinized cells of the epidermis are constantly exfoliated.

Dermatomycetes produce enzymes: keratinases, which destroy keratin.For this reason, the fungi penetrate the superficial layers of the skin, where they continue to exist.The cell wall of dermatomycetes contains manan, substances that can suppress local cellular immunity.The fungus T. rubrum, thanks to the action of manans, prevents the proliferation of keratinocytes, as a result, the desquamation of horny scales from the surface of the skin slows down and a chronic course of the infection develops.

Classification and stages of development of foot mycosis

Classification based on the pathogen:

• Keratomycosis (pityriasis versicolor).
• Dermatophytosis (microsporia, superficial trichophytosis, mycosis of the feet, mycosis of the smooth skin, mycosis of the inguinal folds, onychomycosis).
• Candidiasis (candidiasis of the skin, nails).
• Deep mycoses (blastomycosis, sporotrichosis, chromomycosis).

Classification according to ICD-10:

• B35.1 - Mycosis of the nails.
• B35.2 - Mycosis of the hands.
• B35.3 - Mycosis of the feet.
• B37.2 - Candidiasis of the skin and nails.

Classification by location:

• Skin mycosis.
• Mycosis of the folds.
• Mycosis of the hands.
• Mycosis of the feet (scaly, hyperkeratotic, intertriginous, dyshidrotic form).
• Onychomycosis (distal, superficial, proximal).

Classification by clinic:

• Canceled formmanifests itself as desquamation of the III-IV interdigital folds of the feet.Mild flaking may also occur on the soles of the feet and sides.
• Intertriginous formit manifests itself with hyperemia in the interdigital folds of the feet and it is also possible the appearance of blisters that cause the formation of erosions and cracks.Subjectively, itching and burning are noted.
• With dyshidrotic formGrouped blisters appear on the skin of the arches and lateral surfaces of the feet.More often they appear on healthy skin, then increase in size, coalesce and form larger multichambered blisters.When the blisters open, erosions form.
• Squamous-hyperkeratotic formcharacterized by local or diffuse thickening of the stratum corneum of the lateral and plantar surfaces of the feet.The affected areas of the skin are covered with small pityriasis-like scales.Peeling is especially noticeable in skin folds.The cracks cause pain when walking.

Classification by clinic is very convenient from a practical point of view for determining further treatment tactics and monitoring the patient.

Based on the clinical picture of the disease, one can judge the causative agent of the disease.For example, the dyshidrotic form often manifests itself with mycosis of the feet caused by Trichophyton mentagrophytes var.interdigital, the squamous-hyperkeratotic form is most often associated with T. rubrum, the chronic course and diffuse process are characteristic of the opportunistic fungi Candida spp.and Aspergillus.

Complications of mycosis of the feet

• Mushroom allergy.Under the influence of mushrooms, multipurpose sensitization is formed, that is, the body becomes more sensitive to waste products of the mushroom, which are foreign to us and are strong allergens.The body reacts more sharply, which is manifested by various skin rashes and reactions, chronic diseases of an allergic nature, such as skin eczema.The development or aggravation of pathologies such as bronchial asthma, allergic dermatitis, seborrheic dermatitis and psoriasis is possible.In addition, a person may more often develop professional allergic complications and drug intolerance.

• Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the foot bones), which can lead to long-term deep, unhealed skin wounds.Pyoderma occurs because bacteria easily penetrate through erosions and cracks in the skin (the “gateway to infection”).At the same time, the temperature rises, weakness and malaise appear, requiring immediate surgical correction.
• Increase in viral complicationsin the form of warts due to the presence of hyperkeratosis and cracking.The reason is a violation of the protective function of the skin, as a result of which it becomes more susceptible to any infections, including viral ones.
• General decrease in immunityand impaired microcirculation in the lower limbs in patients with concomitant somatic diseases, such as diabetes mellitus and varicose veins.
• Spread of the disease to the nails and skin of the hands.When nail fungus occurs, they become deformed, an ingrown nail, panaritium (purulent inflammation of the tissues of the fingers), paronychia (inflammation of the periungual fold) and complete detachment of the nail plates are possible.
• Worsening of quality of life.Acute forms of mycosis of the feet are painful, make it difficult to wear shoes, and when lymphadenitis develops they are accompanied by general poor health and fever.

Diagnosis of mycosis of the feet

The diagnosis of mycosis of the feet is based on the patient's complaints, medical history, clinical picture and laboratory results.Foot mycosis are among those diseases that necessarily require laboratory tests to confirm the clinical diagnosis.

The primary method for confirming the diagnosis of mycosis of the feet is microscopic examination and culture.The material is flakes of skin, which are scraped away from the lesion on the skin with a scalpel or glass;less commonly, a tape test is used.

Laboratory diagnosticsmycoses include microscopic and cultural examination of the material for the search for fungi.Microscopic examinationit is a rapid method for diagnosing the pathogen, allowing the structure of the fungi to be identified within a few hours.Microscopic examination may reveal fungal elements in the form of mycelial threads and spores.The disadvantage of the method is that it is possible to obtain both false positive and false negative results, which depend on many factors: the technique of taking the material, the peculiarities of storage and transportation, etc.

Method of cultureit is the most accurate diagnostic method, which allows you to identify the type of fungus to prescribe pathogenic therapy.To prepare for the analysis, the patient is not recommended to use any antifungal agents on his own for 1 month.

When prescribing systemic antifungal therapy, it is recommended to do sobiochemical blood testto determine the level of bilirubin, AST and ALT in connection with the need to monitor the function of the liver and biliary tract, as well as to prevent possible complications.

Differential diagnosis of mycosis of the feet:

• The scaly form differs from psoriasis, eczema and keratoderma.
• The interdigital form differs from impetigo, diaper rash and candidiasis.
• The dyshidrotic form is differentiated from palmoplantar pustulosis.

Treatment of mycosis of the feet

Treatment should be carried out under the supervision of a dermatologist.

The main task in the fight against mycosis of the feet is timely detection, recognition and treatment before the development of nail fungus, which requires longer and more complex therapy (systemic antifungal therapy).At the same time, it is important to have effective drugs that correspond to the modern clinical characteristics of mycosis of the feet.

Before starting treatment for a disease, the dermatologist chooses among the possible therapeutic options.In most cases, drugs are prescribed for topical use.The basis of treatment is the use of antifungal agents that have different effects.Medicines that stimulate blood circulation and drugs to eliminate the main symptoms are also used:

• Antifungal agents for external therapy: applied externally 1-2 times a day for 4 weeks.
• In case of significant hyperkeratosis of the feet, exfoliating therapy is carried out first: a drug from the group of azole derivatives, 1 time a day for 3-4 days, which acts as a keratolytic, that is, it removes the rough layer, thus preparing the skin and improving the penetration of antifungal agents into the dermis.
• If there are bubbles, use Castellani liquid;the solution is applied externally 1-2 times a day for 2-3 days.Then the combined drugs are prescribed 2 times a day externally for 7-10 days.
• For severe itching, antihistamines are prescribed: histamine H blockers₁-receptors – ethanolamine derivative 0.001 g 2 times a day orally for 10-15 days.
• Disinfect the shoes once a month until completely healed;you can use a spray whose active component is undecylenamidopropyltrimonium methosulfate.
• If the nail plates are affected, oral systemic antifungal therapy should be prescribed for a duration of 3-4 months.This therapy requires the supervision of a dermatologist, since self-medication can lead to complications affecting internal organs, mainly the liver, biliary tract, stomach, as well as the ineffectiveness of therapy and the formation of resistance to treatment.

It is necessary to treat mycosis of the feet, because if the fungus has settled in the skin, without treatment it will not go anywhere, which means that the waste products of the fungus will always enter the surrounding tissues and blood, provoking sensitization of the body and the development of chronic diseases of an allergic nature.

The presence of fungi indicates a decrease in immunity, and the skin damaged by mycosis practically does not perform a protective function.Therefore, all conditions are created for the addition of a concomitant bacterial infection.

A patient with mycosis of the feet is an active source of infection for people around him and especially family members, so treatment in this case is an effective means of preventing fungal infection among healthy relatives and people around him.

A favorable environment for the development of fungal infections on the skin of the feet is a humid environment, so you must try to keep the skin of the feet dry at all times.To do this, every evening you need to wash your feet with soap and dry the skin with a disposable paper towel, paying special attention to the space between the toes.

Forecast.Prevention

The prognosis of skin mycosis largely depends on the stage of the disease at which treatment was started.Therefore, if you notice changes in the skin, you should not postpone a visit to the doctor.With timely and correct treatment of mycosis of the feetpredictionfavorable: complete recovery from the fungal infection occurs, the patient recovers.

If left untreated, the fungus can lead to complications that not only deform the shape of the nails, but also affect the condition of the body as a whole.

Preventionfungal infection:

1. Public prevention involves the treatment of public places: bathrooms, saunas, swimming pools, showers.Floors, equipment and household items must be disinfected.Staff and people who frequently visit public baths, saunas, etc.they should undergo regular preventive checks.

2. Primary personal prevention:

   • observe personal hygiene rules when visiting public places;
   • avoid damage and constant moisture to the skin and toenails;
   • wear large, comfortable shoes;
   • Avoid contact with infected people.

3. Secondary personal prevention:

   • maintain a hygienic regime for the skin of the feet;
   • disinfect shoes, showers and bathrooms;
   • increase immunity.